Health literate settings in Austria

Abstract Issue/problem Health literacy (HL) depends largely on how easy or difficult it is in a given situation to find, understand, evaluate and apply health-related information. HL is thus an interplay between personal skills and organisational requirements. Description of the problem In 2018 the Austrian platform for HL initiated the focal point ‘organisational framework conditions for strengthening health literacy’. Since then the needs of organisations are being assessed regularly and several strategies and initiatives have been launched to support organisational HL. Results To support organisations and settings with the implementation of HL a “starter kit” consisting of a general practical guide and several settings specific self-assessment tools (SAT) has been developed. SAT currently exist for hospitals, primary care units, businesses, open youth work, schools and municipalities. For the settings of primary care units as well as open youth work certification processes have been developed, based on the SAT, distribution of high-quality health information and proof of communication trainings. Currently tools for general practitioners are being developed. Lessons Experiences from workshops and pilot testing have shown that organisations need a variety of different tools and measures to help with the implementation of HL. Any type of support needs to be flexible and customisable to different needs and have a low threshold. What is needed most - apart from financial incentives - are settings-based workshops and personal consultation to raise awareness of what health literate organisations can achieve. Main messages: Settings and organisations are important to increase HL in the population. Several settings in Austria have started to implement HL and are at different implementation statuses.


Background:
One way to develop adequate health literacy responsive policy and strategies in hospitals is the use of self-assessment tools to raise awareness, help prioritize action and mobilize stakeholders. In this study we have piloted the French version of the Vienna Health Literate Organisation (V-HLO-fr) tool in three hospitals to explore its feasibility.

Methods:
We performed explorative case studies in the three main hospitals of Liège (Belgium). Our mode of application of the V-HLO-fr was inspired by the 'RAND Appropriateness' method: first, individual members of an internal multidisciplinary panel filled out the questionnaire and then the results were discussed collectively in each hospital during a 'round table' meeting. The feasibility of the process was assessed by direct observation of the round tables and with semi-structured phone interviews Results: The V-HLO-fr tool was fully applied in the three targeted hospitals and the process seems to be acceptable, practicable and integrable. Its mode of application, formalized by taking inspiration from the RAND method, could be further improved, e.g. by paying more attention to recruiting and supporting participants. Strengths (e.g. the facilitation of patient navigation to the hospital) and weaknesses (e.g. the provision of easy to read, understand and act on health information materials) in terms of health literacy responsiveness have been highlighted. Conclusions: V-HLO-fr could be a suitable tool to create awareness and formulate targeted actions to further strengthen hospitals health literacy responsiveness. Those explorative case studies give: -an overall positive signal about the feasibility of the V-HLOfr -useful feedback to further formalize and refine its procedure of application. Issue/problem: Health literacy (HL) depends largely on how easy or difficult it is in a given situation to find, understand, evaluate and apply health-related information. HL is thus an interplay between personal skills and organisational requirements.

Description of the problem:
In 2018 the Austrian platform for HL initiated the focal point 'organisational framework conditions for strengthening health literacy'. Since then the needs of organisations are being assessed regularly and several strategies and initiatives have been launched to support organisational HL.

Results:
To support organisations and settings with the implementation of HL a ''starter kit'' consisting of a general practical guide and several settings specific self-assessment tools (SAT) has been developed. SAT currently exist for hospitals, primary care

Background:
Limited health literacy (LHL) is associated with faster kidney deterioration. To maintain kidney function, health care professionals (HCPs) promote self-management. However, in chronic kidney disease (CKD) care organizations, patients with LHL report multiple communication and self-management barriers. The need for health literacy responsive organizations, and multi-component interventions targeted at patients and HCPs, is recognized. We aimed to determine the objectives and strategies of such an intervention, and to co-create and evaluate it. Methods: First, we performed a longitudinal qualitative study among CKD patients with LHL (n = 24) and HCPs (n = 37) from general practices and nephrology clinics to assess needs and barriers, and to identify promising intervention objectives. Second, we included patients (n = 19), HCPs (n = 15), educators (n = 3) and students (n = 4) in an Intervention Mapping (IM) process to co-create and evaluate the intervention.

Results:
Grip on Your Kidneys (GoYK) addresses the competences of patients with LHL to self-manage CKD on the long-term, and the communication competences of patients and HCPs. Based upon patients' preferences, GoYK encompasses a visually attractive website and brochures to optimize self-management and a card to contribute to consultations. With HCPs, we developed a training to optimize their competences to support patients with LHL. Evaluation revealed the intervention was useful, comprehensive and fitting needs.

Conclusions:
Mapping the needs of CKD patients and HCPs, combined with a process of intervention co-creation, resulted in a multicomponent, positively evaluated intervention. Implementation of this type of interventions in organizations is promising to improve care for patients with LHL. However, the effectiveness of these interventions requires further assessment.

Issue:
Healthcare organizations represent vital points of contact and disseminators for people to find, understand, assess, and apply health information, and may thereby strengthen people's health literacy (HL). From a system perspective, healthcare organizations provide essential practices and structures to foster population health beyond their medical-based services. Description of the problem: Despite increasing research on the promising role of organizational health literacy (OHL) the current Swiss healthcare system provides insufficient support for healthcare organizations to address HL. In response, the Careum Foundation in Zurich recently launched a Center for Health Literacy to promote OHL -among other HL initiatives. A first step was a practice-oriented collaboration project with the Department of Health of the canton of Zurich, which started in 2019 to assess, implement, and improve HL in primary care organizations. Therefore, a self-assessment tool for OHL is being developed, implemented, and evaluated. In addition, the center started to shed light on HL in Switzerland, on HL and necessary competencies of health professionals. Moreover, it is investing in communication and expertise on OHL, and developing first ideas regarding health literate hospitals.

Results:
A first systematic evaluation of the self-assessment tool has demonstrated a significant potential to improve OHL, organizational development, and teambuilding processes in healthcare organizations. Connected through (inter)national networks, the Center for Health Literacy launches a practice approach to understand OHL as both medium and outcome of a health literate population.

Lessons:
We have learned that practice-oriented OHL initiatives can provide promising approaches to strengthen both population health and organizational development processes.

Background:
Health care facilities (i.e., hospitals, care facilities and integration assistance) play an important role in providing health-related information and strengthening health literacy (HL) of patients/clients, staff and at the organizational level. The project ''Development of Health Literacy in Health Care Facilities (EwiKo)' aims at implementing tools to promote and strengthen organizational health literacy (OHL) in health care institutions in Germany. Objectives are 1) to assess needs for strengthening OHL in pilot facilities and 2) to examine factors that are beneficial to strengthen OHL in health care facilities. Methods: N = 6 pilot institutions (n = 2 hospitals, n = 2 care homes for elderly people, n = 2 facilities for people with disabilities) and their members of the ''working groups on HL'' filled in a selfassessment tool to assess the level of OHL, accompanied by